Monday, October 18, 2010

Measuring Outcomes in Disease Management: An Emerging Standard for the Rest of the Health Care Industry

If you're interested in the evaluation of case management, disease management, care management, health promotion, wellness or other programs that are designed to improve quality, reduce costs or increase satisfaction, take it from the Disease Management Care Blog: you need to download this. It's the recently released and FREE 5th Volume of a series of Outcomes Guidelines Reports that collectively describe the various approaches to the evaluation of outcomes in population health management.

Since different programs may have a mix of preventive and care management services, the 5th Volume offers up a checklist and algorithm that helps you decide on an appropriate evaluation methodology. That's followed by some important insights on minimum standards, qualification for inclusions, attribution, statistical adjustments, assessing various evaluation approaches, meeting client expectations, accuracy, validity, selecting a comparator, time spans, outliers and determining denominators and numerators. There's also an important chapter on assessing the impact of wellness programs. And that's all just for starters.

Case in point? Check out this important graphic that describes the Population Health Management "framework":

The image doesn't come close to capturing the detail in the Volume 5 report, but it's notable for two things: 1) in contrast to the Chronic Care Model, it places the person-health care consumer in the middle of system, and 2) it's quite dominated by measurement. In fact, to the DMCB, it almost looks like population health management is being transformed to "applied" real world health services research that breaks down the barriers that have traditionally separated the investigation and the delivery of medical care.

Which brings the DMCB to an insight about the managed care health insurance industry: it thinks one of the reasons it's been so vulnerable to attack is because hasn't been able to build on the initial measurement promise of HEDIS®. It certainly remains an important yardstick for quality among competing plans and it's had its successes. Yet, it's been diluted by a) a slowly expanding process based on hidebound conservatism and quality improvement, b) an aggregation of participating health plans around an uncompelling average and c) declining visibility among buyers, politicians and skeptics - especially during the "government option" debate. While managed care's been sticking to its HEDIS® measures, critics have used other metrics to undercut the insurers' claims that they're all about quality. Fairly or not, they've been accused of cherry picking, rescissions, withholding care, shortchanging doctors and driving up costs. Without objective data and an accepted methodology to assess the extent of those allegations, anecdotes ruled and drove policy. It's still going on. It could be argued that HEDIS® let the health insurers down.

The population health management industry, in the meantime, is fostering a rapidly expanding set of expert measures that not only evaluate the classic clinical domains of care, it's also established processes to measure key economic and quality of life outcomes. With each Report (now up to 5), the industry is leapfrogging its way to a degree of credibility that was absent a few years ago. It may be one of the reasons - despite its proximity to managed care - that it came through health reform largely unscathed.

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Here's what one reader had to say about the Population Health Blog's ability to to go beyond simple headlines and mainstream newsfeeds:

"This past week, I was surprised to read some of the generic headlines summarizing the VA readmission study. You know, through medical newsfeeds, they almost implied that length of stay didn't have anything to do w/readmissions. When I read the Annals article today, there was certainly a lot more to the study than that. Was happy to see your nice summary, which I agree w/100%. Just wanted to drop you a line to say that Ilooked at your blog w/hopes of finding some commentary on the study---and there it was!"

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About Jaan Sidorov MD, MHSA, FACP

While his web persona has been described as a "blogvocateur," Dr. Sidorov has wide range of knowledge about the medical home, condition management, population-based health care and managed care that is only exceeded by his modesty. He has been quoted by the Wall Street Journal, Consumer Reports and NPR’s All Things Considered.
He has over 20 years experience in primary care, disease management and population based care coordination. He is a primary care general internist and former Medical Director at Geisinger Health Plan.
He is primary care by training, managed care by experience and population-based care strategies by disposition.
The contents of this blog reflect only the opinions of Sidorov and should not be interpreted to have anything to do with any current or past employers, clients, customers, friends, acquaintances or enemies, personal, professional, foreign or domestic. This is also not intended to function as medical advice. If you really need that, work with a personal physician or call 911 for crying out loud.
Jaan can be reached at jaansATaolDOTcom.